Tackling non-communicable diseases will require new technologies and societal change, says Sania Nishtar
Non-communicable diseases are front and centre of the discourse around global health. Our emphasis has been on lack of funding, but the issue is much deeper. Non-communicable diseases will radically disrupt the future of global health, and we don’t have the right institutional competencies to deal with it.
They are not just disruptive because of the epidemiological damage that they cause. They are equally disruptive in terms of the political, economic, technological, societal, and health systems responses needed to make a sustained difference.
To mount an effective response, we need a societal transformation towards healthier lifestyle choices; a re-engineering of health systems for chronic care; new cross government norms in trade, commerce, and fiscal decision making; new values underpinning profitability and investment, and a culture of cross government and public-private partnerships that delivers on public outcomes.
We are increasingly aware that we need to tackle non-communicable disease owing to several high level UN summits, institutional advocacy, and its inclusion as a target in sustainable development goal 3.4. This has led to a huge demand for technical assistance from countries. 
But technical assistance will have narrow influence given the limited leverage of ministries of health on the full spectrum of the determinants of non-communicable disease. National and international organisations are not prepared, and do not have the skills and resources, to deal with the issue. The institutional structures that we have developed for infectious diseases will not work for non-communicable diseases. This enormous shift in disease patterns and the necessary response is forcing us to think differently.
The institutional response to non-communicable diseases could be revolutionary for public health. A comparable radical shift came in the wake of the HIV/AIDS movement, which redefined the role of civil society, affected groups, and the importance of health as a human right. Non-communicable diseases have the same potential, especially in terms of defining the rules of engagement in two areas. Firstly, by moving towards a “health in all policies” approach to dealing with public health and, secondly, by increasing engagement with the private sector.
Today, health systems are being re-engineered not by ministries of health, but by financial and online retail institutions. Ensuring that this achieves equity of access and high quality care will require a deeper understanding of how we can use new technologies, which are part of a growing healthcare market.
The solutions are also dependent on societal changes and a shift towards healthier lifestyles, which are currently largely limited to affluent settings. The potential for increasing digitisation, smartphone connectivity, and the wellness industry—the fastest growing global market currently estimated at $3.72tn (£2.86tn; €3.29tn)—to disrupt the global health landscape is huge. These developments need to be harnessed to achieve sustainable development goal. [2,3]
Precision medicine may soon become the default option for disease management. This is evidenced by the declining cost of genome sequencing, advances in pharmacogenetics, use of biobanks, and flexible small volume manufacturing, coupled with the rise in artificial intelligence, big data analytics, and supercomputing power. Most of these developments are part of growing solutions to tackle non-communicable diseases, but financial access barriers will widen.
The future of health may be about the future of non-communicable diseases, but many governance imperatives are emerging in the wake of new technologies and partnerships, in relation to norms and standards and ethical, patient safety, regulatory and human resource capacity issues. Governance mechanisms and capacity are needed to negotiate policy space for non-communicable diseases within existing initiatives, to exercise stewardship when countries are reluctant to enact public health measures for fear of trade or investment disputes, and to support companies and investors that move to divest from products and industries that endanger health.
No existing organisation has the capacity to tackle all aspects of non-communicable diseases. I remain of the view—as I did in 2007—that a new, multi-stakeholder, “cooperative” governance mechanism is need for non-communicable diseases, with input from different sectors and scope beyond the health sector.  A strong governance infrastructure is a fundamental step on which to build on the momentum from the third UN General Assembly high level meeting on non-communicable diseases. Without attention to this we will be setting ourselves up for failure.
Sania Nishtar is the co-chair of the WHO independent high level commission on non-communicable diseases and chair of Benazir Income Support Programme
Competing interests: None
1 World Health Organization. WHO delivering for results Changing ways of working for effective and efficient delivery. http://www.who.int/about/finances-accountability/budget/20170113_delivering-for-results_background-paper_draft.pdf
2 Global Wellness Institute. Wellness now a $3.72 trillion global industry—with a 10.6% growth from 2013-2015. https://globalwellnessinstitute.org/press-room/press-releases/wellness-now-a-372-trillion-global-industry/.
3 Nishtar S. Time for a global partnership on non-communicable diseases. Lancet 2007;370:1887–8. PubMed doi:10.1016/S0140-6736(07)61791-7